House Watch: What Causes Obsessive Hoarding?

“The bitch is back,” House says in last night’s episode, “The Dig,” which featured the return of Olivia Wilde, who had been off filming Tron: Legacy, Cowboys & Aliens and other movies. Our little Thirteen is quickly pushing into Hollywood’s top-10 actresses.

Before the recap, a spoiler alert: If you missed “The Dig,” put down your spud gun and watch it before reading on. The possible diagnoses, as usual, are in bold.

The last time we saw Thirteen, in the season six finale, she put an envelope on House’s desk. It contained her request for a leave of absence. So far during season seven, the writers have given few hints about where she is — possibly because Wilde’s schedule is so busy that it wasn’t clear if Thirteen could ever return. We have known for some time that Thirteen has Huntington’s disease, a genetic disorder that is incurable and associated with a higher rate of suicide, so the audience was left to believe that she may have simply gone off to die.

Instead, in the opening scene last night we find House waiting for Thirteen outside the Middlebury Correctional Institution, a fictional New Jersey prison.

(Side note: He’s waiting for her next to his car — presumably a rental — which is an old, crappy blue Dodge. The car raises an issue I’m always confused about: just how much money do House and his doctors make? Taub is often complaining about money, but Wilson has a stunning home with a trophy kitchen. Why would House have to rent such a cheap vehicle?)

Once Thirteen reaches the car, House fixes her a Martini from a swanky portable bar (again, not a cheap toy). Thirteen drinks it like water.

House immediately starts prying to find out what landed her in prison. Thirteen’s first answer: “Excessive prescribing.” House says this is surely the charge she pleaded to, but it can’t be the whole truth.

Meantime, the team gets a new case: a 36-year-old nonsmoking science teacher who coughed up blood in class. He also has chills, headache, and chest pain — but the ER has ruled out pneumonia, bronchitis, and lung cancer.

Chase, eager to take off since House is out of the office with Thirteen, thinks the teacher has a simple condition, epistaxis (a fancy name for nosebleeds). “Blood runs into his lungs; he coughs it back up. Flu explains the rest of the symptoms,” says Chase.

But the ever-diligent Masters thinks something more complicated is going on — toxic exposure, say. When she and Chase talk to the teacher, he says he showers in the school gym, which isn’t particularly clean. Chase then says the teacher isn’t coughing up blood but red-colored bacteria from serratia infection (which is usually found in food).

Just then, of course, the patient coughs up actual blood.

Taub and Foreman search the man’s home, which is so packed with old books and furniture and bicycles that they believe he’s a hoarder. There’s even a dead cat in the freezer. The place has so much mold that Foreman believes he has aspergillosis, a fungal infection.

The two doctors then confront the patient, who says he’s not a hoarder, “just a major slob.” Taub then points out that the man saves earwax — apparently his home contains a 2-ft. pile of used Q-tips.

But it turns out that aspergillosis can’t be the diagnosis because the teacher’s condition is getting worse at the hospital, in the absence of fungi — his pain has intensified, and he needs oxygen. Foreman wonders if the problem isn’t exposure to toxins in the messy home but lack of exposure to the carbon monoxide emitted at low levels from the man’s heater. CO acts as a vasodilator, which means it keeps blood pressure from rising too high.

And yet when the teacher’s home is checked again, Chase and Masters find no sign of CO. However, Chase does find raccoon droppings that the hoarder has saved in the kitchen. Now the most plausible diagnosis is Q fever, a bacterial animal infection that humans can get when they inhale contaminated animal excrement.

Chase and Masters also find something more important in the home: a woman hiding under a blue tarp. She turns out to the teacher’s wife, and she is actually the hoarder. Once the wife is checked into the hospital, she has a heart attack, which wouldn’t be caused by Q fever.

Foreman then comes to believe the problem is hydrogen sulfide, a chemical given off by rotting food. But when Chase checks the home for the chemical, he finds only about 2 parts per billion, “the size of a healthy fart.”

The dogged Masters finds baby clothes hidden in a closet. She suggests that infertility could have led to the hoarding as a way “to fill the void.” House orders the team to find out whether the infertile one is the man or his wife. In the funniest line of the episode, he says, “Figure out which is fried, the bacon or the eggs.”

The final diagnosis turns out to be Ehlers-Danlos syndrome, a genetic disorder that affects the connective tissue, although the writers do a shoddy job of explaining exactly how the syndrome could have caused all the symptoms.

The problem with the episode is that so much time is spent on this medical mystery that we don’t see enough of Thirteen. There’s a long and rather strange comic bit in which Thirteen helps House build a spud gun for an annual competition he enters, but the premise only works if you constantly keep reminding yourself that House is essentially a teenage boy in a 50-something body. He would like spud guns. But why would Thirteen?

The emotional punch comes when Thirteen finally admits she went to prison for euthanizing her brother, who also had Huntington’s. Thirteen’s character has always been well-conceived: she is so beautiful that her virility excites everyone around her. And yet she’s like a China doll — destined to be broken because of her Huntington’s. At the end, the episode finally delivers on this emotion when House — in a pitch-perfect House M.D. moment — promises to kill Thirteen when the time comes.

I wanted “The Dig” to spend more time with Thirteen, but House M.D. never strays too far from its procedural roots. Still, it was a decent episode with some strong lines for all the actors. Final diagnosis: B+